Modifier -59

New Specific HCPCS Modifiers to Define Distinct Procedural Services

Change Request (CR) 8863, issued August 15, notifies Medicare Administrative Contractors (MACs) that the Centers for Medicare and Medicaid Services (CMS) is establishing four new HCPCS modifiers as a subset of the -59 modifier to define a “Distinct Procedural Service.” Effective date of January 1, 2015 with implementation date of January 5, 2015.

The four new modifiers are:
• XE Separate Encounter - A Service That Is Distinct Because It Occurred During A Separate       Encounter
• XS Separate Structure - A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure
• XP Separate Practitioner - A Service That Is Distinct Because It Was Performed By A Different Practitioner
• XU Unusual Non-Overlapping Service - The Use Of A Service That Is Distinct
    Because It Does Not Overlap Usual Components Of The Main Service.

CMS will continue to recognize the -59 modifier, but notes that Current Procedural
Terminology (CPT) instructions state that the -59 modifier should not be used when a more descriptive modifier is available. While CMS will continue to recognize the -59 modifier in many instances, it may selectively require a more specific – X {XE, XP, XS, XU} modifier for billing certain codes at high risk for incorrect billing. For example, a particular NCCI PTP code pair may be identified as payable only with the -XE separate encounter modifier but not the -59 or other XP, XS, XU modifiers.

The combination of alternative specific modifiers with a general less specific modifier
creates additional discrimination in both reporting and editing. As a default, at this time
CMS will initially accept either a -59 modifier or a more selective - X{EPSU} modifier as
correct coding, although the rapid migration of providers to the more selective modifiers is encouraged. However, please note that these modifiers are valid even before national edits are in place.